Inflammatory Bowel

This page contains educational material about treatmentes for bowel inflammation. This information is for educational purposes only. Nothing in this text is intended to serve as medical advice. All medical decisions should be made only with the guidance of your own personal medical authority. I am doing my best to get this data up quickly and correctly. If you find errors in this data, please let me know.

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This information is taken from a class in 2005. I have not updated it.

General Treatment for Bowel Inflammation

In people who have Crohn’s disease, elemental diets (in which nutrients have been reduced to simple molecules) have been shown to be as effective as corticosteroids at inducing remission (Ogata H et al 2003; O’Keefe SJ 1996). In patients already taking prednisone, the drug was reduced or eliminated in 50 percent of patients who follow an elemental diet. While on an elemental diet, inflammatory parameters and intestinal permeability decrease (Meister D et al 2002; Teahon K et al 1991). This diet does not work for ulcerative colitis.

Allergens: Remove all suspicious foods from the patient’s diet that precipitate inflammation. The following are the most likely to be troublesome: dairy, eggs, nuts, fruit, tomatoes, corn, wheat (or gluten), and for some such as blood type A, red meat. All refined carbohydrates and processed foods should be removed. All fats except for essential fatty acids should be eliminated, because saturated fats and trans fats are detrimental to people with Crohn’s disease (Heckers H et al 1988; Lorenz-Meyer H et al 1996). Olive oil is a good choice of oil to use in meal preparation. Products such as Vivonex®, UltraMaintain®, or UltraClear® can be used at the outset. UltraClear® is preferable because it contains sufficient fiber to maintain regular bowel evacuation. Removal of gastrointestinal parasites, undesirable bacteria, or fungus is important. (see dysbiosis)

Nutrients: The diets of most patients who have inflammatory bowel disease are nutritionally imbalanced. Replacement of vital nutrients consists of a good multivitamin, together with minerals that are lacking. The vitamins that most patients with inflammatory bowel disease lack are the B-complex vitamins such as folic acid and vitamin B6, and particularly vitamin B12 (Rogler G et al 2004). Iron and calcium deficiencies are frequently found in patients with Crohn’s disease (Capurso G et al 2002; Lomer MC et al 2004; Siffledeen JS et al 2003), as well as deficiencies in zinc, protein, vitamin D, and folic acid (Rath HC et al 1998; Siffledeen JS et al 2003). Patients with Crohn’s disease are usually under increased oxidative stress and have lower levels of antioxidant vitamins. Supplementation with vitamins C and E reduces oxidative stress (Aghdassi E et al 2003). Long-term use of corticosteroids warrants the inclusion of supplemental calcium and vitamin D to prevent corticosteroid-induced osteoporosis.

Antioxidants: Normal digestion produces a host of reactive oxygen and nitrogen species (also known as free radicals), against which the intestinal mucosa maintains an extensive system of antioxidants. When presented with excessive oxidant stress, however, the mucosal barrier can sustain damage and become leaky, setting the stage for inflammation.

Inflammation produces large quantities of reactive species, and a destructive cycle can be perpetuated. In patients who have inflammatory bowel disease, there are high levels of reactive oxygen species in the intestines, which contributes to the damage caused by the disease. Oxidative damage is emerging as a key factor in the disease process (Koutroubakis IE et al 2004). The levels and the balance of important antioxidants are impaired within intestinal mucosa in inflammatory bowel disease (Kruidenier L et al 2003). Studies have shown that antioxidant combinations, including vitamin A, vitamin C, vitamin E, and selenium, can reduce the symptoms associated with inflammatory bowel disease (Trebble TM et al 2004, 2005).

Vitamin A: Helps with healing and restoring normal bowel function. Profoundly effects the metabolism and differentiation of the intestinal epithelial mucosa. Can increase the number of goblet cells, increase the production of mucins, increase the secretion of mucus, and restore normal barrier function. - 50,000 IU per day (High doses of vitamin A should not be given to everyone and not long term usually.)

Vitamin B complex—A complete B-complex vitamin that includes high potencies of all the essential B vitamins including B1, B3, B6, and B12

Vitamin C: Low in patients with inflammatory bowel disease, especially in patients with low fiber diets. Thought to be important in prevention of fistula development. - 1000 to 3000 mg/day

Vitamin E: Inhibits leukotriene formation and reduces free radical damage.—400 International Units (IU)/day with at least 200 mg of gamma-tocopherol

Zinc: Speeds healing of ulcers and decreases pain from them. 50 mg/day (copper should be given with zinc if long term - 8:1 zinc to copper.

Selenium: A potent antioxidant necessary for metabolism of calcium and vitamin C. Selenium deficiency is common in people who have inflammatory bowel disease (Ishida T et al 2003; Kuroki F et al 2003). Supplementation may alleviate this problem. 200 micrograms (mcg)/day

Calcium: Low in IBD participants - probably due to loss of absorptive surface, steatorrhea, corticosteroid use, and vitamin D deficiency. - 500-1000 mg calcium chelate per day

Magnesium: Very prevalent in IBD patients. Especially intracellular levels are deficient. They present with weakness, anorexia, hypotension, confusion, hyperirratability, tetany, convulsions, electrocardiographic or elcetroencephalographic abnormalities. - 200-800mg/per day magnesium glycinate. May need other than oral route since it may cause cathartic reaction.

Butyrate: Butyrate (also known as butyric acid) is a short-chain fatty acid produced when intestinal fiber is metabolized by bacteria. Butyrate ameliorates inflammation in ulcerative colitis and Crohn’s disease, but the mechanism is not known. One mechanism by which butyrate may function is to inhibit the activation of a proinflammatory cell–signaling component called nuclear factor kappa B (NF-kappa B). This inhibition makes cells less responsive to proinflammatory cytokines (Segain JP et al 2000). Butyrate is often administered as an enema twice daily and retained for 30 minutes. One study showed butyrate enemas to provide complete remission in 38% of patients while a mix of short chain fatty acids with butyrate, acetate and proprionate to have a 47% remission. The placebo group had 25% remission. The turmeric constituent known as curcumin also inhibits NF-kappa B and can be taken orally. Butyrate enemas—Two enemas a day are suggested for patients who have ulcerative colitis or Crohn’s disease that affects their lower colon. (Butyrate enemas consist of 60 mL of 80 mm sodium butyrate titrated to a pH of 7.0.)

Omega-3 fatty acids: Omega-3 fatty acids are anti-inflammatories. They can be found in cold-water fish such as salmon, halibut, sardines, trout, or herring. (3 grams of fish oil per day is a good way to get omega 3’s) Precursors to the most active omega-3s (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) can be obtained in walnut oil, flaxseed oil, perilla oil, and canola oil. Omega-3 fatty acids have been shown to reduce inflammation in inflammatory bowel disease by reducing the production of inflammatory cytokines (Almallah YZ 1998; Hillier K 1991; Ross E 1993; Steinhart AH 1997). Gamma linolenic acid (GLA), an omega-6 fatty acid found in evening primrose oil, borage seed oil, and blackcurrant oil, is also showing promise in ulcerative colitis (Burke A et al 1997). EPA/DHA—At least 1400 mg/day of EPA and 1000 mg/day of DHA - Gamma Linolenic acid (GLA)—900 to 1800 mg/day
Taking EPA/DHA with warfarin may increase the risk of bleeding. Discontinue using EPA/DHA 2 weeks before any surgical procedure. Taking GLA with warfarin may increase the risk of bleeding.
Discontinue using GLA 2 weeks before any surgical procedure. GLA can cause gastrointestinal symptoms such as nausea and diarrhea.

Glutamine: Glutamine is an amino acid that has been found to help modulate the immune system and protect the mucosal protective layer in the intestine. It has been demonstrated that glutamine can help improve blood flow in inflamed segments of the colon in patients who have ulcerative colitis, although its benefits did not extend to the most seriously affected portion of the colon (Kruschewski M et al 1998). Glutamine is also able to reduce leakiness of the intestine, which may help to reduce symptoms of inflammatory bowel disease. 1000 to 3000 milligrams (mg)/day. Consult your doctor before taking L-glutamine if you have kidney failure or liver failure. L-glutamine can cause gastrointestinal symptoms such as nausea and diarrhea.

Dehydroepiandrosterone (DHEA). DHEA plays an important role in preventing chronic inflammation and provides signals needed to maintain healthy immune function. A deficiency of DHEA has been found to correlate with chronic inflammation. Excess levels of one or more of the inflammatory cytokines (TNF-alpha, IL-6, IL-1b, or LTB4) are usually found when a cytokine blood profile is conducted. DHEA has been shown to lower these proinflammatory cytokines and protect against their toxic effects (Haden ST et al 2000; Kipper-Galperin M et al 1999; Straub RH et al 1998). These proinflammatory cytokines rise with age and are especially high in patients who have inflammatory diseases. DHEA has consistently been shown to boost beneficial interleukin-2 (IL-2) and suppress damaging IL-6 levels.

The deficiency of DHEA in inflammatory diseases also implies a deficiency in peripheral tissue of various sex hormones for which DHEA serves as a precursor. These hormones, both estrogenic and androgenic, are known to have beneficial effects on muscle, bone, and blood vessels. Mainstream therapy with corticosteroids is also known to lower androgen levels. Consequently, researchers believe that hormone replacement for patients who have chronic inflammatory diseases should include not only corticosteroids but also DHEA (Andus T et al 2003; Straub RH et al 2000). Start with 15 to 75 mg (in 3 to 6 weeks have blood tested to make sure optimal blood levels are maintained) Do not take DHEA if you could be pregnant, are breast-feeding, or could have prostate, breast, uterine, or ovarian cancer. DHEA can cause androgenic effects in woman such as acne, deepening of the voice, facial hair growth and hair loss. It may also give them feelings of being irritated or out of control.

Vitamin K: Vitamin K is used by the body to regulate blood clotting. A deficiency in vitamin K can result in bruising or bleeding. Patients with ulcerative colitis are frequently deficient in vitamin K. One study showed that 31 percent of patients who had chronic gastrointestinal disease had a vitamin K deficiency, and all of them had either ulcerative colitis or Crohn’s disease (Krasinski SD et al 1985). Vitamin K—10 mg/day (contraindicated if the person is taking anticoagulants.)

Iron: many people with inflammatory bowel disease are anemic to some degree and should carefully monitor their iron levels. If iron levels are low, supplementation with iron is recommended. A standard dose is 15 mg/day of elemental iron.

Folate/B12: They can also be anemic from lack of folate and or B12. If so, they should be supplemented with these B vitamins.

Fiber: A high-fiber diet may be helpful in reducing flare-ups of colitis. However, during active cases of colitis, fiber should be avoided because of its harshness to the walls of the intestinal tract. Juice from green leafy vegetables is a better alternative. After healing occurs, soluble fibers can be reintroduced into the diet.

Probiotics and Prebiotics
A normal healthy intestine contains 5 to 7 pounds of friendly bacteria, the good bacteria that are responsible for manufacturing some vitamins and cell food in the intestine. In a diseased intestine, these bacteria are not present in adequate amounts or are absent, having been replaced by pathogenic organisms or yeast overgrowth. These flora are needed to keep bad bacteria in check. Reinoculating consists of taking mixtures of the friendly bacteria Lactobacillus acidophilus, Lactobacillus bulgaricus, Bifidobacteria bifidum, Saccharomyces boulardii, along with fructooligosaccharides to promote continued repopulation with these beneficial bacteria (Fedorak RN et al 2004). Inhibition of pathogens by lactobacilli follows the lowering of pH through liberation of acids, resulting in an antimicrobial action. Stool samples provide information regarding these overgrowth factors, pH, and the balance of fatty acids. Probiotics—300 mg, three times daily, of Life Flora, or 900 mg, three times daily, of Primal Defense or Pro-Biotic Complex, 2 capsules 2-3 times per day. These products contain beneficial bacteria.

It is beneficial to treat recurrent Ulcerative Colitis that comes on after antibiotic treatment with Lactobacillus rhamnosus GG. During antibiotic treatment Lactobacillus plantarum can be used.

Decrease intestinal permeability: Frequently the lining of the small intestine becomes permeable, allowing antigens and other incompletely digested products to pass through the bowel wall. Repair of the protective layer consists of adding nutrients such as pantothenic acid (vitamin B5), zinc (Cario E et al 2000; Kapp A et al 1991; Weimann BI et al 1999), and vitamin C to build up the integrity of the intestinal wall itself.

Sometimes the persons gut is so inflamed that they are sensitive to foods, nutrients and herbs, the best herb to start with is Licorice - Glycyrrhiza glabra. It is very healing, immunomodulating and decreases inflammation. It can usually be counted on to help but not cause any irritation. A tea is best in this case.

Ginger: An extract of ginger called zerumbone has been shown to reduce inflammatory biomarkers in animals that have inflammatory bowel disease (Murakami A et al 2003). Ginger is used as an antiinflammatory in many conditions. Ginger extract—250 mg/day or use ginger tea, tincture or capsules.

Demulcents: Alterations in mucin composition and content in the colonic mucosa have been reported in patients with Ulcerative Colitis, but not Crohne’s. Using demulcents helps to replace this lack of mucus and may help protect against colon cancer as mucin abnormalities have been implicated as a factor in the increased risk of colon cancer in these patients.

General categories of herbs to consider are demulcents antiinflammatories, vulnerarys - other possibilities depending on cause of condition and symptoms are tonifying astringents, antimicrobials, antiparasitics and immunomodulators.

Marshmallow Althea officinalis 10-25%
Geranium Geranium maculatum 10-25%
Echinacea Echinacea angustifolia 10-25%
Slippery elm Ulmus rubra 10-25%
Turmeric Curcuma longa 10-25%
Goldenseal Hydrastis canadensis 5-10%

This formula is anti-microbial, anti-inflammatory and healing to mucous membranes.
Profiles of herbs used in this formula:
Marshmallow, Althea officinalis, is anti-inflammatory, mucilaginous and soothing. It promotes normal growth of intestinal mucosa. 10
Geranium, Geranium maculatum, is extremely astringent. It is useful with both pale, relaxed, atonic tissues as well as red, engorged, inflamed tissues. It has a stimulating, tonifying effect upon the gastric mucosa and is helpful in almost all cases of inflammation and edema. Geranium is a styptic and can decrease passive bleeding.
Echinacea, Echinacea angustifolia, is anti-microbial, anti-inflammatory, antifungal and an immuno-modulator. 255 It decreases inflammatory allergic reactions to mild food allergies and stimulates gastric healing.
Slippery elm. Ulmus rubra, is extremely soothing and healing to the gut wall. It is useful for ulcers, generalized inflammatory conditions and hiatal hernia.
Turmeric, Curcuma longa, is used to stimulate the normal flow of digestion, protect the digestive tract from overgrowth of unwanted organisms and decrease digestive tract irritation and inflammation. It is antibacterial, antifungal, carminative and stimulates digestive enzymes. 52 Tumeric is also an anti-inflammatory, a cholagogue and choleretic, and a vulnerary. 51, 52, 53 Goldenseal, Hydrastis canadensis, is well known for its anti-bacterial and antiparasitic action. It is also an astringent and is useful with both pale relaxed tissues and red, engorged tissues. Small doses have a stimulating and tonifying effect upon the gastric tissues. It is a styptic and can decrease passive bleeding. Berberine, a constituent found in goldenseal, has been shown to be effective against bacteria, yeast, protozoa, giardia, visceral and cutaneous leishmaniasis, cholera and amebiasis.

Bastyr’s Formula - from Dr. Bastyr
Marshmallow - Althea officinalis 8 parts
Echinacea - Echinacea angustifolia 8 parts
Geranium - Geranium maculatum 8 parts
Goldenseal - Hydrastis canadensis 8 parts
Poke root - Phytolacca americana 8 parts
Slippery elm - Ulmus fulva 8 parts
Cabbage powder 8 parts
Baptisia tinctoria 4 parts
Pancreatin 2 parts
Duodenal tissue 2 parts
Niacinamide one part

Marshmallow - Althea officinalis
Use: (a) Antispasmodic, 10 (b) Anti-inflammatory. 10
Marshmallow is used for soothing mucous membrane irritation in the gastrointestinal tract, respiratory tract and urinary tract. Its anti-inflammatory activity appears to potentiate the effects of topical steroids. Used for inflammation and ulcers of the mouth, throat, stomach, intestines.
Contraindications: Oral drugs or herbs taken at the same time as marshmallow may have delayed absorption due to its mucilage content.

Echinacea - Echinacea angustifolia
Use: (a) Antimicrobial, (b) Anti-inflammatory, (c) Antiviral, 60 (d) Antibacterial, (e) Antifungal, (f) Slight stimulation of the adrenal cortex, (g) Stimulates leukocytes, 56 (h) Inhibits hyaluronidase, (i) Enhances phagocytosis. 255
Echinacea protects the gut from harmful micro-organisms due to its enhancement of phagocytosis. It also decreases inflammatory allergic reactions in mild food allergies and stimulates gastric healing.
Contraindications: Echinacea is not associated with acute or chronic toxicity. 61

Geranium - Geranium maculatum
Use: (a) Styptic, (b) Mucous membrane tonic.
Used for atonic tissues with discharges due to over-relaxation. Used for passive hemorrhages, diarrhea, ulceration of the mucous membranes and digestive tract, as well as venous atony.
The astringency of this herb makes it useful in any circumstance with abundant and debilitating discharges.
Geranium contains gallic acid, tannic acid, gum, pectin, starch, resin. The tannin is highest in spring roots collected prior to flowering.
Contraindications: Information unavailable at this time.

Goldenseal - Hydrastis canadensis
Use: (a) Alterative, (b) Astringent, (c) Laxative in small doses, (d) Adrenolytic, 77 (e) Styptic, (f) Bitter tonic, (g) Antimicrobial.
Goldenseal is used in mucous membrane problems. It is used in atonic chronic mucosal problems with pale relaxed tissues as well as subacute mucosal membrane problems with red, engorged tissues. Small doses have a stimulating, tonifying effect upon the gastric tissues. It decreases passive bleeding. It also stimulates the normal action of the liver and gall bladder.
Goldenseal contains the alkaloids, berberine and hydrastine. Berberine, found in gold thread (Coptis chinensis), goldenseal (Hydrastis canadensis) and Oregon grape root (Mahonia spp.), is a choleretic shown to triple bile secretion for 1.5 hours and is effective against bacteria, yeast and protozoa. 192 Clinically, berberine has been used to treat giardia, cholera, amebiasis, as well as visceral and cutaneous leishmaniasis.
Contraindications: Goldenseal may exacerbate “adrenal burnout” symptoms such as hypoglycemia, shakiness and hypotension. The fresh plant may cause mucosal irritation. 400 It is contraindicated in pregnancy due to uterine stimulation from berberine, hydrastine, canadine and hydrastinine in animal uteri studies, unless used under the guidance of a qualified health care practitioner. 400 Goldenseal has become endangered. Only organic goldenseal should be used.

Poke root - Phytolacca americana
Use: (a) Lymphagogue, (b) Alterative, (c) Anti-inflammatory, (d) Emetic, (e) Cathartic, (f) Antifungal.
Poke promotes removal of catabolic wastes. In this formula the physician was using it to heal ulcers. It is certainly going to help as a lymphagogue.
Contraindications: Direct contact with the fresh plant may cause external skin irritation and can be toxic when used internally in excessive doses. An overdose can cause nausea, vomiting, oral and gastric irritation, cramps, slowed respiration, drowsiness, tingling over the whole body, weakness, sweating, tetanic convulsions and reduced blood pressure and pulse. Death is possible due to respiratory paralysis. Poke should only be used under the guidance of a qualified health care practitioner. It is contraindicated in pregnancy.
Slippery elm - Ulmus fulva
Use: (a) Mucilaginous demulcent, (b) Diuretic, (c) Anti-inflammatory, (d) Bulking laxative
Slippery elm is indicated for soothing mucous membrane irritation in the gastrointestinal tract. Internally, it is used for inflammatory disorders, inflammation and ulceration of the mouth, throat, stomach, intestines.
Contraindications: When consumed in dry form, this herb should always be taken with water.

Cabbage powder
Cabbage juice has a history and has been studied for its ability to heal ulcers. Some people have digestive problems with cabbbage though so be watchful if using this as a healing agent.

Wild Indigo - Baptisia tinctoria
Use: (a) Alterative, (b) Antimicrobial, (c) Immunomodulator, (d) Lymphagogue, (e) Bitter, (f) Choleretic, (g) Cholagogue.
Wild indigo activates macrophages and increases interleukin-1 production. It assists the body’s natural resistance to micro-organisms and toxins. It is used for septic conditions with ulceration and tissue degeneration. Wild indigo promotes normal cellular metabolism that supports healthy tissues. It is indicated for asthenic symptoms, low fevers, septic conditions of the blood, poisoning, extreme prostration, ulcerative colitis, and amebic dysentery.
Contraindications: It is contraindicated in pregnancy. Large doses are toxic, inducing signs and symptoms of nausea, vomiting, diarrhea, ptyalism, tachycardia, respiratory paralysis and death. Wild indigo should only be used under the guidance of a qualified health care practitioner.

Pancreatin is a digestive enzyme that is used to supplement loss of or low digestive enzymes. Pancreatin contains amylase, lipase, and protease

Duodenal tissue
A protomorphogen to assist in intestinal repair and healing of ulcers.

Niacinamide - B3
For antiinflammatory effects.

Surgery: A Last Resort
In severe or advanced cases of Crohn’s disease, abscesses can develop in chronically inflamed tissues. These abscesses can grow and tunnel through tissue barriers to produce fistulas, or pathways between organs. More than one third of patients who have Crohn’s disease develop perianal disease involving anal fissures and perianal abscesses and fistulas. These symptoms seldom respond well to conventional therapies (Braunwald E 2001; McNamara DA et al 2004). Surgery may be required to drain abscesses or remove and close fistulas (Danelli P et al 2003). Surgery on inflamed tissue is itself potentially dangerous, and complications are frequent.

Surgery may also be recommended to remove severely inflamed portions of the intestinal tract. The goal of surgery is to preserve as much of the intestine as possible. Surgery commonly involves the colon or small intestine. Occasionally, the end of the intestine that has been left in place will need to be brought to the skin’s surface. When this procedure involves the small intestine, it is called an ileostomy. If the procedure involves the colon, it is called a colostomy. Although Crohn’s disease may recur after surgery, the symptoms are likely to be less severe and less debilitating than they were previously. However, when the disease does recur, it usually does so at the site of the last surgery.

In patients with ulcerative colitis, surgery is indicated for up to half of patients in the first decade of their illness. At one time, the surgery of choice was removal of the anus and a portion of the lower colon, which resulted in lifelong incontinence and an ileostomy. Newer surgeries, however, have been developed that can preserve fecal continence by using part of the ileum to create a pouch that is connected to the intact rectal sphincter.

The Protective Effect of Folate on Colon Cancer in Ulcerative Colitis
People with ulcerative colitis appear to be at increased risk of colon cancer (Mitamura T et al 2002). About 5 percent of people with ulcerative colitis develop colon cancer. The risk of cancer increases with the duration and the extent of involvement of the colon. For people with ulcerative colitis, there are two factors affecting the risk of developing colon cancer. The first factor is that risk increases after 8 to 10 years of having ulcerative colitis. The second is the extent of the disease in the colon. Patients who have ulcerative colitis only in the rectum have the lowest risk. Having the disease in only part of the colon carries an intermediate risk. The greatest risk is for people whose entire colon is diseased (called pancolitis) (Itzkowitz SH et al 2004). It is assumed that chronic inflammation is what causes cancer in ulcerative colitis. This is supported by the fact that colon cancer risk increases with longer duration of colitis, greater anatomic extent of colitis, and the concomitant presence of other inflammatory manifestations (Itzkowitz SH et al 2004).

Two case-control studies have shown that folate may protect against the development of colon cancer caused by ulcerative colitis. The most recent study showed that folate use for at least 6 months reduced the risk of colon cancer by 28 percent in 98 patients who had ulcerative colitis for at least 8 years. Of the patients with ulcerative colitis, 29.6 percent developed cancerous lesions. The greater the dose of supplemental folate consumed, the lower the rate of colon cancer. Scientists concluded that “daily folate supplementation may protect against the development of neoplasia in ulcerative colitis” (Lashner BA et al 1997). Supplementing the diet with vitamin B12 enables the body to metabolize folate better and avoids masking a vitamin B12 deficiency. Vitamin B12 supplementation is important, particularly for older people (when it is less effectively absorbed) and for vegetarians (because vitamin B12 is found only in red meat). Supplementation with folic acid and vitamin B12 (800 mcg of folic acid and 300 mcg of vitamin B12) has been shown to reduce the risk of colon cancer.

B12 should always be given with folate. Due to B12 absorption problems sublingual or injection is best.

Inflammatory Bowel Disease Raises Homocysteine Levels
A number of studies have shown that patients with inflammatory bowel disease are more likely to have elevated homocysteine levels. (Elevated homocysteine levels are associated with atherosclerosis.) In one study, more than 55 percent of patients with inflammatory bowel disease had elevated homocysteine levels (Roblin X et al 2006). The greatest risk factor for elevated homocysteine in patients with inflammatory bowel disease is reduced folate levels (Zezos P et al 2005). Vitamin B12 deficiencies are also frequently encountered (Mahmood A et al 2005). Certain drugs used to treat inflammatory bowel disease, such as methotrexate, are antimetabolites for folic acid, which may help explain why so many patients are deficient in this vital nutrient.

The elevated homocysteine level that is typical in patients with inflammatory bowel disease accounts for a 3-fold higher risk of blood clots and vascular disease (Fernandez-Miranda C et al 2005; Srirajaskanthan R et al 2005). It also helps explain why patients with inflammatory bowel disease are more likely to have early atherosclerosis (Papa A et al 2005). Based on these findings, it is logical that patients with inflammatory bowel disease should take a prophylactic B complex vitamin, with adequate folic acid and vitamin B12 since these vitamins are known to decrease homocysteine levels
Inflammatory Bowel Disease and Bone Loss
Osteoporosis is a serious complication of inflammatory bowel disease that has not received adequate recognition. Data derived from a retrospective survey of 245 patients with inflammatory bowel disease suggest that the prevalence of bone fractures in people with ulcerative colitis and Crohn’s disease is unexpectedly high, particularly in patients who have a long duration of disease, frequent active phases, and high cumulative doses of corticosteroid intake (Bischoff SC et al 1997; Gassull MA 2003; Vanis N et al 2003). Recent advances in the diagnosis and management of osteoporosis have facilitated early detection of bone loss and identified means by which it may be prevented. Bone-density measurements to predict fracture risk and define thresholds for prevention and treatment should be performed routinely in patients with inflammatory bowel disease (Rogler G et al 2004).

Corticosteroids can also contribute to the risk of osteoporosis because of their effects on calcium and bone metabolism. Corticosteroids suppress calcium absorption in the small intestine, increase calcium excretion by the kidneys, and alter protein metabolism. Patients with inflammatory bowel disease who are taking corticosteroids experience a 6.2 percent annual loss of total bone mass compared with only a 0.9 percent annual loss of total bone mass in patients who are not taking corticosteroids. Nutrients that can help protect bone loss include calcium, vitamin D, trace minerals (boron, zinc, copper, silica, manganese) co-factors for enabling calcium crystal formation, providing structure and order to bone tissue (Vitamin K, folic acid). These can all be found in a product called Osteoblend by Vitanica.

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